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Greca AL, Iacobone E, Elisei D, Biasucci DG, D'Andrea V, Barone G, Zito Marinosci G, Pittiruti M. ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients. J Vasc Access 2023; 24:535-544. [PMID: 34494474 DOI: 10.1177/11297298211044325] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice.
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Affiliation(s)
- Antonio La Greca
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Daniele Guerino Biasucci
- Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi di Rimini, Azienda Unità Sanitaria Locale della Romagna, Rimini, Italy
| | - Geremia Zito Marinosci
- UOC di Rianimazione e Neuroanestesia, Azienda Ospedaliera Santobono-Pausilipon, Naples, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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2
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Kosiński S, Podsiadło P, Stachowicz J, Mikiewicz M, Serafinowicz Z, Łukasiewicz K, Mendrala K, Darocha T. Ultrasound-guided, long-axis, in-plane, infraclavicular axillary vein cannulation: A 6-year experience. J Vasc Access 2023; 24:754-761. [PMID: 34727764 DOI: 10.1177/11297298211054629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite its potential advantages, ultrasound-guided cannulation of the axillary vein in the infraclavicular area is still rarely used as an alternative to other techniques. There are few large series demonstrating the safety and feasibility of this approach. METHODS Retrospective analysis of data on patients undergoing ultrasound-guided, long-axis, in-plane infraclavicular axillary vein cannulation for the incidence of complications and the failure rate from two secondary-care hospitals. RESULTS The analysis included 710 successful attempts of axillary vein long-axis, in-plane, US-guided cannulation, and 24 (3.3%) failed attempts. We recorded a 96.7% success rate with an overall incidence of complications of 13%, mainly malposition (8.1%). There was one case of pneumothorax (0.14%), five cases of arterial puncture (0.7%), and two cases of brachial plexus injury. CONCLUSIONS The US-guided axillary central venous cannulation (CVC) access technique can be undertaken successfully in patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it should be adopted more widely in clinical practice.
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Affiliation(s)
- Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Podsiadło
- Institute of Medical Sciences, Jan Kochanowski University Medical College, Kielce, Poland
| | - Jakub Stachowicz
- Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
| | - Maciej Mikiewicz
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Zofia Serafinowicz
- Department of Anesthesiology and Intensive Care, District Hospital, Zakopane, Poland
| | - Katarzyna Łukasiewicz
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Konrad Mendrala
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
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3
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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4
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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5
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Pitman JS, Buscemi M, Funk EM, Weaver S, Thompson JA, Falyar C. Incorporating Evidence-based Ultrasound-guided Vascular Access (USGVA) Standards Into the Nurse Anesthetist Armamentarium: A Quality Improvement Project. J Perianesth Nurs 2023:S1089-9472(22)00603-7. [PMID: 36658031 DOI: 10.1016/j.jopan.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE This quality improvement (QI) project developed and implemented a hybrid training program, that included online modules and hands-on training for experienced certified registered nurse anesthetists (CRNAs) to increase confidence, knowledge, and competency with ultrasound-guided vascular access (USGVA). DESIGN This QI project used a pre-post design. Seventeen volunteer CRNAs participated in USGVA training and education, and a 90-day follow-up assessment was performed. METHODS The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used as a framework to assess confidence, knowledge, and hands-on competency of 17 CRNAs who regularly place vascular access devices using USGVA in patients with difficult vascular access at a single facility. These assessments were measured at: (1) baseline, (2) immediately after attending a hybrid training educational program, and (3) 90 days after implementation into clinical practice. Additionally, the number of vascular access attempts required for successful placement of peripheral intravenous (PIV) catheters, arterial catheters, and central venous catheters (CVC) with ultrasound assistance over a 90-day period was reviewed. FINDINGS Certified registered nurse anesthetists' median confidence score increased significantly from pre- to post-education (P = .009). The confidence reported from post- to 90 days post-education improved, however it did not reach statistical significance (P = .812). The knowledge scores from pre- to post-education indicated significant improvement (P <. 001), as well as from pre- to 90 days post-education (P = .03). However, knowledge scores from post- to 90 days post-education revealed a statistically significant decline (P = .004). The overall median score for hands-on USGVA competency declined from post- to 90 days post-education (P = .109). The number of successful USGVA placements increased from 50% to 80% within a 90-day period. CONCLUSIONS The implementation of a USGVA hybrid training and education program improved overall provider confidence, knowledge, and competency. While confidence remained high in the 90-day follow-up, knowledge retention declined. Despite a decline in knowledge retention over time, results showed a significant improvement when compared to baseline scores. Although a decline in hands-on USGVA competency was seen at 90 days posteducation, it was not statistically significant. The percentage of overall successful USGVA placements in clinical practice increased following implementation.
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Affiliation(s)
| | | | | | - Shanna Weaver
- University of North Carolina - Chapel Hill, Department of Anesthesiology
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6
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Alsbrooks K, Hoerauf K. Comparative Effectiveness, Efficiency, and ED Nurse Preference Between Two Methods of Visualization for Midline Catheter Insertion: A Pilot Study. SAGE Open Nurs 2023; 9:23779608221150721. [PMID: 36643785 PMCID: PMC9834413 DOI: 10.1177/23779608221150721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Rapid and reliable peripheral IV access is essential for many patients admitted to the emergency department (ED) to ensure administration of life-saving medications, and successful intravenous cannulation can significantly affect patient care. Objective The objective of this study was to assess the impact of a continuous needle tracking system on the accuracy, speed, and quality of ultrasound-guided peripheral venous catheter insertions. Methods A convenient sample study based on the study setting using simulated tissue was conducted with 49 US-based ED nurses to compare the insertion of a midline catheter using traditional ultrasound guidance versus an advanced needle-tracking technology along with ultrasound guidance. The purpose of this evaluation was to assess the impact of continuous needle tracking system. Informed consent was obtained from all individual participants involved in this study. All participants were made aware that the results may be published. There was no IRB approval for this study. All sources were properly disclosed within the text. Results The addition of the advanced needle-tracking technology significantly reduced total insertion attempts, insertion time, backwall penetrations, and redirects (probes to hit the target vein), while improving image clarity and confidence for participants. Conclusion The innovative needle-tracking system evaluated in this pilot study has the potential to improve emergent difficult vascular access. EDs should assess the value of this technology to potentially improve the management of difficult intravenous access patients in their settings.
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Affiliation(s)
- Kimberly Alsbrooks
- Becton Dickinson and Co, Franklin Lakes, NJ, USA,Kimberly Alsbrooks, Becton Dickinson and Co, Franklin Lakes, NJ, USA.
| | - Klaus Hoerauf
- Becton Dickinson and Co, Franklin Lakes, NJ, USA,Department of Anesthesiology and Intensive Care, Medical University, Vienna, Austria
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7
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Kopanczyk R, Kumar N, Papadimos T. Post-Acute COVID-19 Syndrome for Anesthesiologists: A Narrative Review and a Pragmatic Approach to Clinical Care. J Cardiothorac Vasc Anesth 2021; 36:2727-2737. [PMID: 34688543 PMCID: PMC8487462 DOI: 10.1053/j.jvca.2021.09.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
Post-acute coronavirus disease 2019 (COVID-19) syndrome is a novel, poorly understood clinical entity with life-impacting ramifications. Patients with this syndrome, also known as "COVID-19 long-haulers," often present with nonspecific ailments involving more than one body system. The most common complaints include dyspnea, fatigue, brain fog, and chest pain. There currently is no single agreed-upon definition for post-acute COVID-19 syndrome, but most agree that criterion for this syndrome is the persistence of mental and physical health consequences after initial infection. Given the millions of acute infections in the United States over the course of the pandemic, perioperative providers will encounter these patients in clinical practice in growing numbers. Symptoms of the COVID-19 long-haulers should not be minimized, as these patients are at higher risk for postoperative respiratory complications and perioperative mortality for up to seven weeks after initial illness. Instead, a cautious multidisciplinary preoperative evaluation should be performed. Perioperative care should be viewed through the prism of best practices already in use, such as avoidance of benzodiazepines in patients with cognitive impairment and use of lung-protective ventilation. Recommendations especially relevant to the COVID-19 long-haulers include assessment of critical care myopathies and neuropathies to determine suitable neuromuscular blocking agents and reversal, preoperative workup of insidious cardiac or pulmonary pathologies in previously healthy patients, and, thorough medication review, particularly of anticoagulation regimens and chronic steroid use. In this article, the authors define the syndrome, synthesize the available scientific evidence, and make pragmatic suggestions regarding the perioperative clinical care of COVID-19 long-haulers.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Nicolas Kumar
- The Ohio State University College of Medicine, Columbus, OH
| | - Thomas Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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8
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Vessel health and preservation: Development and validation of a proactive instrument. Collegian 2021. [DOI: 10.1016/j.colegn.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Pagliuca S, Bailly C, Talbot A, Bertinchamp R, Peyrony O, Elezi A, Bourrier P, Lengline E. Point-of-care ultrasound with handheld devices in hematology: a monocentric single-stage phase II study. Leuk Lymphoma 2021; 62:1379-1385. [PMID: 33416408 DOI: 10.1080/10428194.2020.1869958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Point of care ultrasound (PoCUS) with pocket-size devices is an efficient and safe imaging modality that became a standard of care in various clinical settings. However, its implementation in hematology has never been evaluated so far. We conducted a prospective monocentric study aiming to harvest data on its usage and to assess its diagnostic and interventional performance in improving the accuracy of basic physical examination in hematological patients. After a focused training program, six hematologists were trained and conducted this study. Sixty-two patients were included. Only in 19 cases, further specialized imaging was required, whereas, in 43 patients PoCUS was sufficient to address the clinical inquiries. The use of PoCUS devices was assessed for its performance difficulty and usefulness perception with satisfactory outcomes. This study represents a proof-of-concept application of PoCUS in hematology, suggesting benefits over the physical examination.KEY POINTSPoCUS is particularly attractive in a hematological setting because able to improve the accuracy of physical examination.A hematology-focused training in PoCUS using handheld devices can allow hematologists to perform bed-side diagnostic and interventional US-based exams.
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Affiliation(s)
- Simona Pagliuca
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Emergency Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Cecile Bailly
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
| | - Alexis Talbot
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
| | - Rémi Bertinchamp
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
| | - Olivier Peyrony
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Emergency Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Arben Elezi
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Emergency Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Pierre Bourrier
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Radiology Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Etienne Lengline
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
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10
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Nauka PC, Galen BT. The Focused Assessment with Sonography in Cancer (FASC) Examination. POCUS JOURNAL 2020; 5:42-45. [PMID: 36896442 PMCID: PMC9979872 DOI: 10.24908/pocus.v5i2.14428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Malignant effusions occur frequently in patients with cancer and are important to diagnose and treat. In this report, we describe a novel point-of-care ultrasound (POCUS) protocol to rapidly identify pleural effusion, pericardial effusion, and ascites: The Focused Assessment with Sonography in Cancer (FASC). This protocol utilizes six standard sonographic positions to identify the presence of fluid in common anatomic spaces. The FASC examination is intended for widespread use by oncologists and other clinicians who treat patients with cancer.
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Affiliation(s)
- Peter C Nauka
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Internal Medicine, Residency Training Program Bronx, NY USA
| | - Benjamin T Galen
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Internal Medicine, Division of Hospital Medicine Bronx, NY USA
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11
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Corvino A, Catalano O, de Magistris G, Corvino F, Giurazza F, Raffaella N, Vallone G. Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: imaging findings and diagnostic performance study. J Ultrasound 2020; 23:563-573. [PMID: 32436181 DOI: 10.1007/s40477-020-00475-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
The pseudoaneurysm (PA) is a perfused sac directly connecting with the arterial lumen by an interruption of the vessel wall continuity, more commonly secondary to trauma or iatrogenic causes. Aim of our study was to determine the accuracy and usefulness of Doppler techniques in the diagnosis of peripheral iatrogenic PAs secondary to minimally invasive procedures. From a three year prospective research, 20 Duplex Ultrasound (DUS) studies in as many patients presenting with periarterial pulsating mass clinically suspected for PA secondary to minimally invasive procedures were selected. The PA final diagnosis was confirmed by angiography in 12 patients (60% cases), by computed tomography angiography in 5 patients (25%), by surgery in 2 patients (10%), and by magnetic resonance angiography in 1 patient (5%). The vessels involved by PA formation were: common femoral artery in 8 cases (40%); superficial femoral artery in 4 cases (20%); brachial artery in 3 cases (15%); popliteal artery in 2 cases (10%); superficial temporal artery (STA) in 2 cases (10%); dorsal medial digital artery of the foot in 1 case (5%). Our study confirmed the usefulness of doppler techniques in the diagnosis of peripheral iatrogenic PAs. Specifically, a sensitivity of 90-95%, a specificity of 100% and predictive values of 100% (VPP) and 83-90% (VPN) were reported. The radiologist must always suspect a PA in the differential diagnosis of lesions contiguous to an artery vessel. This is to prevent potential complications such as e.g. massive haemorrhage. In this order, DUS allows a careful selection of patients who require to undergo in-depth imaging methods or surgical therapy, thus contributing to a significant reduction of contrast medium and exposure to ionizing radiation.
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Affiliation(s)
- Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", Via F. Acton 38, 80133, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Giuseppe de Magistris
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Niola Raffaella
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Gianfranco Vallone
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), Via S. Pansini 5, 80131, Naples, Italy
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European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol 2020; 37:344-376. [DOI: 10.1097/eja.0000000000001180] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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13
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Barth D, Sanchez A, Thomsen AM, Garcia A, Malachowski R, Weldon R, Mayhew M, Mudie K, Faller D, Schwartz J. Peripheral vascular access for therapeutic plasma exchange: A practical approach to increased utilization and selecting the most appropriate vascular access. J Clin Apher 2020; 35:178-187. [PMID: 32191358 DOI: 10.1002/jca.21778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is used in the treatment of many diseases. At present, peripheral vascular access (PVA) is an underutilized method of vascular access in TPE. It should be considered more frequently due its relatively low risk for adverse events, particularly infections. METHODS The Advancing Vascular Access in Apheresis Working Group met in December 2017 for an extensive review and discussion of vascular access for TPE and developed a "road map" providing detailed information regarding clinical situations in which PVA-based TPE would and would not be appropriate. RESULTS The road map is consistent with current recommendations that PVA should be used in combination with TPE whenever possible. PVA should be considered for patients who do not have existing central lines and who are stable. The patient should have peripheral veins that will allow for adequate treatment and must be able to comply with the process of achieving and maintaining peripheral access. There should be expert clinical assessment of veins, and this evaluation may include ultrasound and/or near infrared evaluation. Conditions that would prompt a switch from PVA to an alternate method of venous access include loss of venous access, patient preference, or development of a requirement for very frequent treatment over a long period of time. CONCLUSIONS While PVA is not suitable for all patients requiring TPE, it has significant safety advantages over other approaches and should be employed whenever possible.
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Affiliation(s)
- David Barth
- Department of Laboratory Medicine and Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Amber Sanchez
- Department of Medicine, University of California, San Diego, California, USA
| | - Anna-Marie Thomsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Alicia Garcia
- USCF Children's Hospitals, Oakland and San Francisco, California, USA
| | - Roman Malachowski
- Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland
| | - Rebecca Weldon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Kari Mudie
- Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | | | - Joseph Schwartz
- Colombia University Medical Centre, New York City, New York, USA
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14
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Imataki O, Shimatani M, Ohue Y, Uemura M. Effect of ultrasound-guided central venous catheter insertion on the incidence of catheter-related bloodstream infections and mechanical complications. BMC Infect Dis 2019; 19:857. [PMID: 31619174 PMCID: PMC6796423 DOI: 10.1186/s12879-019-4487-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023] Open
Abstract
Background Central venous catheters (CVCs) are necessary for critically ill patients, including those with hematological malignancies. However, CVC insertion is associated with inevitable risks for various adverse events. Whether ultrasound guidance decreases the risk of catheter-related infection remains unclear. Methods We observed 395 consecutive CVC insertions between April 2009 and January 2013 in our hematological oncology unit. Because the routine use of ultrasound guidance upon CVC insertion was adopted based on our hospital guidelines implemented after 2012, the research period was divided into before December 2011 (early term) and after January 2012 (late term). Results Underlying diseases included hematological malignancies and immunological disorders. In total, 235 and 160 cases were included in the early- and late term groups, respectively. The median insertion duration was 26 days (range, 2–126 days) and 18 days (range, 2–104 days) in the early- and late term groups, respectively. The internal jugular, subclavian, and femoral veins were the sites of 22.6, 40.2, and 25.7% of the insertions in the early term group and 32.3, 16.9, and 25.4% of the insertions in the late term group, respectively. The frequency of catheter-related bloodstream infection (CRBSI) was 1.98/1000 catheter days and 2.17/1000 catheter days in the early- and late term groups, respectively. In the subgroup analysis, the detected causative pathogens of CRBSI did not differ between the two term groups; gram-positive cocci, gram-positive bacilli, and gram-negative bacilli were the causative pathogens in 68.9, 11.5, and 14.8% of the cases in the early term group and in 68.2, 11.4, and 18.2% of the cases in the late term group, respectively. In the multivariate analysis to determine the risk of CRBSI, only age was detected as an independent contributing factor; the indwelling catheter duration was detected as a marginal factor. A significant reduction in mechanical complications was associated with the use of ultrasound guidance. Conclusions Ultrasound-guided CVC insertion did not decrease the incidence of CRBSI. The only identified risk factor for CRBSI was age in our cohort. However, we found that the introduction of ultrasound-guided insertion triggered an overall change in safety management with or without the physicians’ intent.
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Affiliation(s)
- Osamu Imataki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-town, Kita-county, Kagawa, 761-0793, Japan.
| | - Mami Shimatani
- Nursing Division, Kagawa University Hospital, Kagawa, Japan
| | - Yukiko Ohue
- Nursing Division, Kagawa University Hospital, Kagawa, Japan
| | - Makiko Uemura
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-town, Kita-county, Kagawa, 761-0793, Japan
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Franco-Sadud R, Schnobrich D, Mathews BK, Candotti C, Abdel-Ghani S, Perez MG, Rodgers SC, Mader MJ, Haro EK, Dancel R, Cho J, Grikis L, Lucas BP, Soni NJ. Recommendations on the Use of Ultrasound Guidance for Central and Peripheral Vascular Access in Adults: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14:E1-E22. [PMID: 31561287 DOI: 10.12788/jhm.3287] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 02/02/2023]
Abstract
PREPROCEDURE 1)We recommend that providers should be familiar with the operation of their specific ultrasound machine prior to initiation of a vascular access procedure. 2)We recommend that providers should use a high-frequency linear transducer with a sterile sheath and sterile gel to perform vascular access procedures. 3)We recommend that providers should use two-dimensional ultrasound to evaluate for anatomical variations and absence of vascular thrombosis during preprocedural site selection. 4)We recommend that providers should evaluate the target blood vessel size and depth during preprocedural ultrasound evaluation. TECHNIQUES General Techniques 5) We recommend that providers should avoid using static ultrasound alone to mark the needle insertion site for vascular access procedures. 6)We recommend that providers should use real-time (dynamic), two-dimensional ultrasound guidance with a high-frequency linear transducer for central venous catheter (CVC) insertion, regardless of the provider's level of experience. 7)We suggest using either a transverse (short-axis) or longitudinal (long-axis) approach when performing real-time ultrasound-guided vascular access procedures. 8)We recommend that providers should visualize the needle tip and guidewire in the target vein prior to vessel dilatation. 9)To increase the success rate of ultrasound-guided vascular access procedures, we recommend that providers should utilize echogenic needles, plastic needle guides, and/or ultrasound beam steering when available. Central Venous Access Techniques 10) We recommend that providers should use a standardized procedure checklist that includes the use of real-time ultrasound guidance to reduce the risk of central line-associated bloodstream infection (CLABSI) from CVC insertion. 11)We recommend that providers should use real-time ultrasound guidance, combined with aseptic technique and maximal sterile barrier precautions, to reduce the incidence of infectious complications from CVC insertion. 12)We recommend that providers should use real-time ultrasound guidance for internal jugular vein catheterization, which reduces the risk of mechanical and infectious complications, the number of needle passes, and time to cannulation and increases overall procedure success rates. 13)We recommend that providers who routinely insert subclavian vein CVCs should use real-time ultrasound guidance, which has been shown to reduce the risk of mechanical complications and number of needle passes and increase overall procedure success rates compared with landmark-based techniques. 14)We recommend that providers should use real-time ultrasound guidance for femoral venous access, which has been shown to reduce the risk of arterial punctures and total procedure time and increase overall procedure success rates. Peripheral Venous Access Techniques 15) We recommend that providers should use real-time ultrasound guidance for the insertion of peripherally inserted central catheters (PICCs), which is associated with higher procedure success rates and may be more cost effective compared with landmark-based techniques. 16)We recommend that providers should use real-time ultrasound guidance for the placement of peripheral intravenous lines (PIV) in patients with difficult peripheral venous access to reduce the total procedure time, needle insertion attempts, and needle redirections. Ultrasound-guided PIV insertion is also an effective alternative to CVC insertion in patients with difficult venous access. 17)We suggest using real-time ultrasound guidance to reduce the risk of vascular, infectious, and neurological complications during PIV insertion, particularly in patients with difficult venous access. Arterial Access Techniques 18)We recommend that providers should use real-time ultrasound guidance for arterial access, which has been shown to increase first-pass success rates, reduce the time to cannulation, and reduce the risk of hematoma development compared with landmark-based techniques. 19)We recommend that providers should use real-time ultrasound guidance for femoral arterial access, which has been shown to increase first-pass success rates and reduce the risk of vascular complications. 20)We recommend that providers should use real-time ultrasound guidance for radial arterial access, which has been shown to increase first-pass success rates, reduce the time to successful cannulation, and reduce the risk of complications compared with landmark-based techniques. POSTPROCEDURE 21) We recommend that post-procedure pneumothorax should be ruled out by the detection of bilateral lung sliding using a high-frequency linear transducer before and after insertion of internal jugular and subclavian vein CVCs. 22)We recommend that providers should use ultrasound with rapid infusion of agitated saline to visualize a right atrial swirl sign (RASS) for detecting catheter tip misplacement during CVC insertion. The use of RASS to detect the catheter tip may be considered an advanced skill that requires specific training and expertise. TRAINING 23) To reduce the risk of mechanical and infectious complications, we recommend that novice providers should complete a systematic training program that includes a combination of simulation-based practice, supervised insertion on patients, and evaluation by an expert operator before attempting ultrasound-guided CVC insertion independently on patients. 24)We recommend that cognitive training in ultrasound-guided CVC insertion should include basic anatomy, ultrasound physics, ultrasound machine knobology, fundamentals of image acquisition and interpretation, detection and management of procedural complications, infection prevention strategies, and pathways to attain competency. 25)We recommend that trainees should demonstrate minimal competence before placing ultrasound-guided CVCs independently. A minimum number of CVC insertions may inform this determination, but a proctored assessment of competence is most important. 26)We recommend that didactic and hands-on training for trainees should coincide with anticipated times of increased performance of vascular access procedures. Refresher training sessions should be offered periodically. 27)We recommend that competency assessments should include formal evaluation of knowledge and technical skills using standardized assessment tools. 28)We recommend that competency assessments should evaluate for proficiency in the following knowledge and skills of CVC insertion: (a) Knowledge of the target vein anatomy, proper vessel identification, and recognition of anatomical variants; (b) Demonstration of CVC insertion with no technical errors based on a procedural checklist; (c) Recognition and management of acute complications, including emergency management of life-threatening complications; (d) Real-time needle tip tracking with ultrasound and cannulation on the first attempt in at least five consecutive simulation. 29)We recommend a periodic proficiency assessment of all operators should be conducted to ensure maintenance of competency.
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Affiliation(s)
| | - Daniel Schnobrich
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Benji K Mathews
- Department of Hospital Medicine, Regions Hospital, Health Partners, St. Paul, Minnesota
| | - Carolina Candotti
- Division of Hospital Medicine, University of California Davis, Davis, California
| | - Saaid Abdel-Ghani
- Department of Hospital Medicine, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Martin G Perez
- Department of Hospital Medicine, Memorial Hermann Northeast Hospital, Humble, Texas
| | - Sophia Chu Rodgers
- Division of Pulmonary Critical Care Medicine, Lovelace Health Systems, Albuquerque, New Mexico
| | - Michael J Mader
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas
| | - Elizabeth K Haro
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas
| | - Ria Dancel
- Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Joel Cho
- Department of Hospital Medicine, Kaiser Permanente Medical Center, San Francisco, California
| | - Loretta Grikis
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | | | - Nilam J Soni
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas
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16
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Piredda M, Fiorini J, Facchinetti G, Biagioli V, Marchetti A, Conti F, Iacorossi L, Giannarelli D, Matarese M, De Marinis MG. Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence. J Clin Nurs 2019; 28:3492-3504. [PMID: 31162862 DOI: 10.1111/jocn.14941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/24/2019] [Accepted: 05/26/2019] [Indexed: 01/25/2023]
Abstract
AIMS AND OBJECTIVES To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. BACKGROUND Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. DESIGN The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses. METHODS The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. RESULTS Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. CONCLUSIONS An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. RELEVANCE TO CLINICAL PRACTICE Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.
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Affiliation(s)
- Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Jacopo Fiorini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Gabriella Facchinetti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Valentina Biagioli
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Fabio Conti
- Nursing Department, University Hospital Tor Vergata, Rome, Italy
| | - Laura Iacorossi
- National Center for Clinical Excellence, Quality and The Safety of Care' (CNEC), Istituto Superiore di Sanità, Rome, Italy
| | - Diana Giannarelli
- Biostatistical Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Matarese
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
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17
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Aydın T, Balaban O, Koçulu R, Tokur ME. Where is the Guidewire? Confirmation of Central Catheter Placement in the Brachiocephalic Vein Using Y-shape Visualization by Ultrasound. Cureus 2019; 11:e4124. [PMID: 31049273 PMCID: PMC6483115 DOI: 10.7759/cureus.4124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Central venous catheter placement with ultrasound guidance improves the success rate and reduces the number of puncture attempts and complications. Y-shape visualization of central veins using an endocavity micro-convex ultrasound probe is a new technique, which has been used for brachiocephalic vein cannulation. Since the jugular, subclavian, and brachiocephalic veins can be visualized in a single view using the Y-shape technique, it can also be used to confirm the correct placement of the catheter or guidewire. We aimed to present a case in which the location of the guidewire was verified by Y-shape visualization with an endocavity micro-convex probe after a cannulation attempt. Successful internal jugular vein catheterization was achieved with the assistance of the Y-shape imaging technique and the patient was avoided from multiple cannulation attempts.
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Affiliation(s)
- Tayfun Aydın
- Anesthesiology, Kutahya Health Sciences University, Kutahya, TUR
| | - Onur Balaban
- Anesthesiology, Kutahya Health Sciences University, Kutahya, TUR
| | - Rabia Koçulu
- Anesthesiology, Kutahya Health Sciences University, Kutahya, TUR
| | - Murat Emre Tokur
- Internal Medicine, Kutahya Health Sciences University, Kutahya, TUR
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18
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Duwadi S, Zhao Q, Budal BS. Peripherally inserted central catheters in critically ill patients - complications and its prevention: A review. Int J Nurs Sci 2019; 6:99-105. [PMID: 31406874 PMCID: PMC6608659 DOI: 10.1016/j.ijnss.2018.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 01/16/2023] Open
Abstract
Peripherally inserted central catheter (PICC) is extensively used in critical care settings, because it plays a vital role in providing safe central venous entry. However, PICC is associated with several complications, which should be detected to shorten the duration of patients' improvement, reduce health care cost, and lessen the incidence of various PICC-related complications. Therefore, this study aimed to outline current literature on PICC procedures, potential complications, and measures for prevention. Understanding evidence-based guidelines regarding insertion technique, early detection of complications, and care bundle of PICC is significant in complication prevention. Implementation of education, training, and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications. Thus, the strict care of indwelling PICC lines, the targeted and reasonable PICC-associated complication prevention, and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.
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Affiliation(s)
- Sona Duwadi
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Birendra Singh Budal
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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19
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Bastos MG, Novaes AKB, Pazeli JMP. Traditional and ultrasound physical examinations: a hybrid approach to improve clinical care. ACTA ACUST UNITED AC 2018; 64:474-480. [PMID: 30304149 DOI: 10.1590/1806-9282.64.05.474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/09/2017] [Indexed: 11/21/2022]
Abstract
Point-of-care ultrasonography, which is performed at the bedside by physicians who are not specialists in imaging, has become possible thanks to recent technological advances that have allowed for a device with greater portability while maintaining image quality. The increasing use of point-of-care ultrasonography in different specialties has made it possible to expand physical examinations, make timely decisions about the patients and allows the performance of safer medical procedures. In this review, three cases from our experience are presented that highlight the use of point-of-care ultrasonography by clinicians. Bedside ultrasonography is a convenient modality used in a clinical setting to aid in early diagnosis of several common conditions. It is suggested that a hybrid approach of physical examination and point-of-care ultrasonography in the everyday clinical practice is an inevitable change of paradigm that is improving quality of care in a variety of clinical settings.
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Affiliation(s)
- Marcus Gomes Bastos
- Department of Clinical Medicine, Faculty of Medicine of the Federal University of Juiz de Fora, Juiz de Fora, /MG, Brasil
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20
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Reynolds TA, Amato S, Kulola I, Chen CJJ, Mfinanga J, Sawe HR. Impact of point-of-care ultrasound on clinical decision-making at an urban emergency department in Tanzania. PLoS One 2018; 13:e0194774. [PMID: 29694406 PMCID: PMC5918616 DOI: 10.1371/journal.pone.0194774] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/11/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Point of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be particularly useful in resource-limited settings. However, its impact on clinical decision making in such settings has not been well studied. The objective of this study is to describe the utilization and impact of PoCUS on clinical decision making at an urban emergency department in Dar es Salaam, Tanzania. METHODS This was a prospective descriptive cross-sectional study of patients receiving PoCUS at Muhimbili National Hospital's Emergency Medical Department (MNH EMD). Data on PoCUS studies during a period of 10 months at MNH EMD was collected on consecutive patients during periods when research assistants were available. Data collected included patient age and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic impression and disposition plan before and after PoCUS. Descriptive statistics, including medians and interquartile ranges, and counts and percentages, are reported. Pearson chi squared tests and p-values were used to evaluate categorical data for significant differences. RESULTS PoCUS data was collected for 986 studies performed on 784 patients. Median patient age was 32 years; 56% of patients were male. Top indications for PoCUS included trauma, respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians reported that the use of PoCUS changed either diagnostic impression or disposition plan in 29% of all cases. Rates of change in diagnostic impression or disposition plan increased to 45% in patients for whom more than one PoCUS study type was performed. CONCLUSIONS In resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications and has substantial impact on clinical decision making, especially when more than one study type is performed.
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Affiliation(s)
- Teri Ann Reynolds
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Emergency Medicine and Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Stas Amato
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America
| | - Irene Kulola
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Chuan-Jay Jeffrey Chen
- School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Juma Mfinanga
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Hendry Robert Sawe
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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21
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Souto Barros F, Salles-Cunha SX, Roelke LH, Morais Filho DD, Paula Brandão NAD, Pontes SM. Arterial Compression of Left Iliac Veins: Five-Year Patency Rates of Endovascular Treatment. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1544316718763388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Endovascular angioplasty and stenting have become a treatment of choice for severely symptomatic left iliac veins under external, arterial compression. Patency rates of stented iliac veins based on ultrasonographic (US) findings were estimated. Retrospective analyses of gender, age, deep venous thrombosis (DVT) prior to stenting, stent location at common and/or external iliac veins, and patency rates from 1 month to 5 years were performed. Patients treated were mostly women (72 of 79, 91%), aged 51 ± 16 (25-89) years. Patency rates were 96% at 1 month, 89% at 1 year, and 85% at 3 to 5 years, best for common iliac, 95%, than for external iliac vein stents, subgroup with prior DVT, with secondary patency rates of 75%. US demonstrated acceptable patency rates for iliac vein stenting showing good performance for common iliac vein stents but a decreased performance with stent extending to the external iliac vein or stents placed in patients with prior iliac DVT.
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22
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Ultrasound for central vascular access. A safety concept that is renewed day by day. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Zanolla GR, Baldisserotto M, Piva J. How useful is ultrasound guidance for internal jugular venous access in children? J Pediatr Surg 2018; 53:789-793. [PMID: 28843837 DOI: 10.1016/j.jpedsurg.2017.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/22/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to determine whether US reduces number of puncture attempts, procedure time, and complication rate during IJV access in children. METHODS A prospective study was performed in children (age ≤18years) admitted to our institution, from September 2013 to July 2014, with indications for central venous access. Patients meeting the inclusion criteria were randomized to the US-guided or control groups. The same physician performed all IJV cannulations in both groups. The end-points for comparison were: length of time to venous access, number of attempts, and rate of complications. RESULTS Fifty-one patients were included: 23 in the US-guided group and 28 in the control group. There were no between-group differences in weight, age, or sex. In the US-guided group, the number of punctures needed to achieve IJV access (median [interquartile range], 3 [2-5] vs. 1 [1, 2]; P<0.001), time to achievement of venous access, and complication rate (39% vs. 4.3%, P<0.009) were significantly lower. CONCLUSION US guidance is a useful adjunct to central venous access in children, facilitating the procedure, decreasing time to cannulation, and increasing safety. TYPE OF STUDY Prospective randomized study. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Gabriela Ruschel Zanolla
- Universidade Federal de Santa Maria (UFSM), Hospital Universitário de Santa Maria, 97105-340, Av. Roraima, 1000, Prédio 22, Santa Maria, RS, Brazil.
| | - Matteo Baldisserotto
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), 90619-900, Av. Ipiranga, 6681, Porto Alegre, RS, Brazil; Department of Radiology, Center for Molecular Imaging, PUCRS Brain Institute, 90619-900, Av. Ipiranga, 6681, Porto Alegre, RS, Brazil.
| | - Jefferson Piva
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), 90035-903, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil; Pediatric Emergency and Intensive Care Department, Hospital de Clínicas de Porto Alegre (HCPA), 90035-903, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil.
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24
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Smit JM, Raadsen R, Blans MJ, Petjak M, Van de Ven PM, Tuinman PR. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018. [PMID: 29534732 PMCID: PMC5851097 DOI: 10.1186/s13054-018-1989-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US). Methods This is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool. Results We included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8–99.5) and sensitivity of 68.2 (95% CI: 54.4–79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77–2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6–36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate. Conclusions US is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed. Electronic supplementary material The online version of this article (10.1186/s13054-018-1989-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasper M Smit
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Reinder Raadsen
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michiel J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Manfred Petjak
- Department of Intensive Care medicine, Groene Hart Ziekenhuis, Bleulandweg 10, 2803 HH, Gouda, The Netherlands
| | - Peter M Van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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25
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Aydın K, Tokur ME, Ergan B. A Rare Vascular Anomaly during Central Venous Catheterization: A Persistent Left-Sided Superior Vena Cava. Turk Thorac J 2018; 19:46-48. [PMID: 29404186 DOI: 10.5152/turkthoracj.2017.17020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
Abstract
A persistent left-sided superior vena cava (PLSVC) is the most frequent abnormality of the venous system; however, it is not a very well-known variation among physicians. Herein we report the case of a patient with a PLSVC who was diagnosed after central venous catheterization (CVC). An 80-year-old man was admitted to the emergency room with cardiopulmonary arrest. After the return of spontaneous circulation, CVC was blindly performed from the left jugular vein without any complications. However, routine chest X-ray after catheterization revealed that the catheter was moving down directly to the left heart. Thoracic computed tomography showed the right brachiocephalic vein draining into the left brachiocephalic vein and forming the left superior vena cava in front of the aortic arch. The left superior vena cava merged into the right atrium after crossing the left pulmonary artery. CVC is widely used in clinical practice, and therefore clinicians should be aware of possible variations in central veins, particularly during blind catheterization.
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Affiliation(s)
- Kutlay Aydın
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Murat Emre Tokur
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Department of Intensive Care Unit, Dokuz Eylül University School of Medicine, İzmir, Turkey
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26
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Shin SY, Kim H, Choi YS, Kim SW. Usefulness of Doppler waveform analysis before performing a complex procedure using femoral venous access. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:157-159. [PMID: 29159810 DOI: 10.1002/jcu.22564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/09/2017] [Accepted: 02/05/2017] [Indexed: 06/07/2023]
Abstract
Ultrasonography is a well-defined and widely accepted technique in the settings of interventional procedures requiring peripheral venous access, either for the confirmation of the vein patency (with the compression test) or for guiding needle insertion. This report describes a case of unsuccessful guidewire passage through the right iliac vein in spite of successful ultrasonography-guided puncture of the femoral vein. On repeat duplex ultrasonography, the Doppler waveform showed a continuous pattern without respiratory phasicity, which was consistent with proximal venous occlusion. Venous Doppler signal waveform analysis can be helpful for ensuring downstream patency when planning long-distance catheterization via femoral venous access.
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Affiliation(s)
- Seung Yong Shin
- Department of Cardiology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hyangkyoung Kim
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yoo Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sang Wook Kim
- Department of Cardiology, College of Medicine, Chung-Ang University, Seoul, Korea
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Hoffman T, Du Plessis M, Prekupec MP, Gielecki J, Zurada A, Tubbs RS, Loukas M. Ultrasound-guided central venous catheterization: A review of the relevant anatomy, technique, complications, and anatomical variations. Clin Anat 2017; 30:237-250. [PMID: 27521991 DOI: 10.1002/ca.22768] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Taryn Hoffman
- Department of Anatomical Sciences, School of Medicine; St. George's University; West Grenada Indies
| | - Maira Du Plessis
- Department of Anatomical Sciences, School of Medicine; St. George's University; West Grenada Indies
| | - Matthew P. Prekupec
- Department of Internal Medicine; University of Nevada School of Medicine; Las Vegas NV
| | - Jerzy Gielecki
- Department of Anatomy; University of Warmia and Mazury in Olsztyn; Poland
| | - Anna Zurada
- Department of Radiology, Warmia and Mazury; University Hospital; Poland
| | | | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine; St. George's University; West Grenada Indies
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Merchaoui Z, Lausten-Thomsen U, Pierre F, Ben Laiba M, Le Saché N, Tissieres P. Supraclavicular Approach to Ultrasound-Guided Brachiocephalic Vein Cannulation in Children and Neonates. Front Pediatr 2017; 5:211. [PMID: 29051889 PMCID: PMC5633682 DOI: 10.3389/fped.2017.00211] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022] Open
Abstract
The correct choice of intra vascular access in critically ill neonates should be individualized depending on the type and duration of therapy, gestational and chronological age, weight and/or size, diagnosis, clinical status, and venous system patency. Accordingly, there is an ongoing demand for optimization of catheterization. Recently, the use of ultrasound (US)-guided cannulation of the subclavian vein (SCV) has been described in children and neonates. This article gives an overview of the current use of US for achieving central venous catheter placement in the SCV or the brachiocephalic vein (BCV) in neonates. More than 1,250 catheters have been reported inserted in children and neonates for a cumulated success rate of 98.4% and the complication rate is reported to be low. The technical aspects of various approaches are discussed, and we offer our recommendation of an US-guided technique for SCV and BCV cannulation based on our experience in a large NICU setting. Although the cannulation the SCV or BCV does not substitute the use of peripherally inserted central catheters or umbilical venous central catheters in neonates, it is a feasible route in very small children who are in need of a large caliber central venous access.
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Affiliation(s)
- Zied Merchaoui
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Ulrik Lausten-Thomsen
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell, CNRS, CEA, University of Paris Sud, Paris Saclay University, Gif-sur-Yvette, France
| | - Florence Pierre
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Maher Ben Laiba
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nolwenn Le Saché
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Tissieres
- Pediatric and Neonatal Intensive Care Unit, Paris South University Hospitals, Le Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell, CNRS, CEA, University of Paris Sud, Paris Saclay University, Gif-sur-Yvette, France
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Reynolds TA, Noble J, Paschal G, Sawe HR, Sohoni A, Shah S, Nicks B, Mwafongo V, Stein J. Bedside ultrasound training at Muhimbili National Hospital in Dar es Salaam, Tanzania and Hospital San Carlos in Chiapas, Mexico. Afr J Emerg Med 2016; 6:125-131. [PMID: 30456078 PMCID: PMC6234160 DOI: 10.1016/j.afjem.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 02/06/2016] [Accepted: 03/08/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In resource-rich settings, bedside ultrasound has rapidly evolved to be a crucial part of emergency centre practice and a growing part of critical care practice. This portable and affordable technology may be even more valuable in resource-limited environments where other imaging modalities are inaccessible, but the optimal amount of training required to achieve competency in bedside ultrasound is largely unknown. We sought to evaluate the feasibility of implementation of a mixed-modality bedside ultrasound training course for emergency and generalist acute care physicians in limited resource settings, and to provide a description of our core course components, including specific performance goals, to facilitate implementation of similar initiatives. METHODS We conducted a standardised training course at two distinct sites-one large, urban tertiary hospital in Tanzania with a dedicated Emergency Centre, and one small, rural, hospital in southern Mexico with a general, acute intake area. We report on pre-training ultrasound use at both sites, as well as pre- and post-training views on most useful indications. RESULTS Overall, participants were very satisfied with the course, although approximately one-third of the providers at both sites would have preferred more hands-on training. All participants passed a standardised exam requiring image acquisition and interpretation. DISCUSSION Introducing bedside ultrasound training in two distinct resource-limited settings was feasible and well-received. After a brief intensive period of training, participants successfully passed a comprehensive examination, including demonstration of standardised image acquisition and accurate interpretation of normal and abnormal studies.
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Dietrich CF, Horn R, Morf S, Chiorean L, Dong Y, Cui XW, Atkinson NSS, Jenssen C. Ultrasound-guided central vascular interventions, comments on the European Federation of Societies for Ultrasound in Medicine and Biology guidelines on interventional ultrasound. J Thorac Dis 2016; 8:E851-E868. [PMID: 27747022 DOI: 10.21037/jtd.2016.08.49] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Central venous access has traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. There is substantial evidence demonstrating significant improvement in effectiveness and safety of vascular access by realtime ultrasound (US)-guidance, as compared to the anatomical landmark-guided approach. This review comments on the evidence-based recommendations on US-guided vascular access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Rudolf Horn
- Notfallstation, Kantonsspital Glarus, Glarus, Switzerland
| | - Susanne Morf
- Intensivmedizin Kantonsspital Graubünden, Chur, Switzerland
| | - Liliana Chiorean
- Department of Medical Imaging, des Cévennes Clinic, Annonay, France
| | - Yi Dong
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Xin-Wu Cui
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Nathan S S Atkinson
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany
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Abstract
PURPOSE OF REVIEW Ultrasound-guided cannulation of the internal jugular vein has become a standard practice over recent years. Despite known benefits, ultrasound is less frequently used for other vascular applications probably because these are technically demanding and require more experience. The authors of this review focus on pitfalls of ultrasound guidance: most important practical aspects as well as nonroutine vascular applications are discussed. RECENT FINDINGS Ultrasound guidance increases the first-pass and overall success rates and reduces the risk of complications of central venous catheterization through the subclavian and femoral routes, as well as arterial and difficult peripheral venous access. Ultrasound is also useful to detect catheter malposition and complications. Technical improvements and new modifications of old ultrasound-guided techniques may result in better outcomes. SUMMARY Growing evidence suggests that routine utilization of ultrasound guidance is beneficial for all types of vascular access. The presence of a skilled operator and proper technique are, however, required to achieve success and avoid complications.
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Czyzewska D, Ustymowicz A, Klukowski M. [Application of ultrasonography in central venous catheterization; access sites and procedure techniques]. Med Clin (Barc) 2016; 147:116-20. [PMID: 27157792 DOI: 10.1016/j.medcli.2016.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
Central venous catheterization is commonly performed in clinical practice. Traditional procedural technique is based on anatomical landmarks, but is associated with a high risk of failure and complications. To decrease their incidence European and American societies recommend application of ultrasonography. Preliminary ultrasonographic examination allows for assessment of local anatomical relations as well as vessel morphology (diameter, patency), while real-time ultrasonography increases chances of successful needle insertion. This paper presents the most common venous access sites and procedure techniques.
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Affiliation(s)
- Dorota Czyzewska
- Department of Diagnostic Imaging, Independent Public Provincial Hospital of J. Sniadecki, Bialystok, Polonia.
| | - Andrzej Ustymowicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Polonia
| | - Mark Klukowski
- Department of Pediatrics, Gastroenterology, and Allergology, Medical University of Bialystok, Bialystok, Polonia
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Buzançais G, Roger C, Bastide S, Jeannes P, Lefrant JY, Muller L. Comparison of two ultrasound guided approaches for axillary vein catheterization: a randomized controlled non-inferiority trial. Br J Anaesth 2016; 116:215-22. [PMID: 26787790 DOI: 10.1093/bja/aev458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Axillary vein catheterization via a distal approach is an alternative to the proximal approach to axillary/subclavian vein catheterization under ultrasound (US) guidance. The aim of this trial was to compare the two approaches. METHODS In a randomized single-centre study, all patients requiring central vein catheterization in intensive care or the operating room were randomly assigned to proximal or distal approach groups. If catheterization failed after two attempts using the approach allocated, the non-allocated approach was used. The primary endpoint was the initial success rate of distal to compared with the proximal approach, using a non-inferiority analysis (lower limit 90% CI greater than -8% non-inferiority margin for group difference). The secondary endpoints were: overall success rates, catheter position and complications. RESULTS 119/122 included patients were analysed (57 and 62 in the proximal and distal axillary approach groups, respectively). Primary success rates for proximal and distal sites were 87.7 and 85.5%, respectively (difference -2.2%, 90% CI [-12.5-8.1%], non-inferiority P=0.18). The proximal and distal overall success rates were 96.5 and 98.4%, respectively (difference -1.9%, 90% CI [-4.9-8.7%], non-inferiority P<0.01). Thrombogenic catheter positions were 7 (12.3%) in proximal approach group vs 19 (31.7%) in the distal approach group (P=0.01). Complications were comparable in the two groups (2 (3.3%) vs 4 (6.5%), P=0.68). CONCLUSION In terms of absolute and overall success rates, a distal approach is not non-inferior to a proximal approach. Although associated with a more thrombogenic catheter extremity position, the distal approach can be considered as a rescue alternative after failure of a proximal approach. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01543360.
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Affiliation(s)
- G Buzançais
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine Anaesthesiology Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine
| | - C Roger
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy, Nîmes 30000, France
| | - S Bastide
- Department of Biostatistics and Clinical Epidemiology, Nimes University Hospital, Place du Pr Debré, Nîmes cedex 9 30029, France
| | - P Jeannes
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine
| | - J Y Lefrant
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy, Nîmes 30000, France
| | - L Muller
- Critical Care Unit, Department of Anaesthesiology, Critical Care, Pain and Emergency Medicine EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Boulevard Kennedy, Nîmes 30000, France
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Retrospective Observational Review of Percutaneous Cannulation for Extracorporeal Membrane Oxygenation. ASAIO J 2016; 62:325-8. [DOI: 10.1097/mat.0000000000000339] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Fuzier R, Rougé P, Pierre S. Abords veineux périphériques échoguidés. Presse Med 2016; 45:177-82. [DOI: 10.1016/j.lpm.2015.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/30/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
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Intraoperative spine ultrasound: application and benefits. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:865-9. [DOI: 10.1007/s00586-015-4222-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/29/2015] [Accepted: 08/31/2015] [Indexed: 11/26/2022]
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Standard Procedures of Endovascular Treatment for Vascular Access Stenosis in our Facility – Clinical Usefulness of Ultrasonography. J Vasc Access 2015; 16 Suppl 10:S34-7. [DOI: 10.5301/jva.5000460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/20/2022] Open
Abstract
In Japan, the number of patients receiving dialysis is 314,180 at the end of 2013 and 97% are treated with hemodialysis. And the mean age of patients and the percentage of diabetes have been increasing. For this reason, preparations of a new vascular access (VA) and its long-term maintenance have become difficult. In the guidelines by the Japanese Society for Dialysis Therapy (JSDT), endovascular treatment (ET) is positioned as the first line for VA stenosis. The procedure of ET itself is very simple. The revision of Japanese health insurance set an expensive technical fee for ET in 2012. It also added a restriction by which the claims for both technical and material fees would be denied, if the treatment was performed within 3 months after a previous treatment. This makes determination of best treatment timing more important. The functional evaluation using ultrasonography (US) is a useful monitoring index for determination of the ET timing for patients with stenosis. We investigated the cumulative relative frequency of flow volume (FV) and resistant index (RI) of brachial artery in arteriovenous graft (AVG) and arteriovenous fistula (AVF) cases with access failures. As a result, the cut-off values of FV and RI in AVG were 480 mL/min and 0.57, and in AVF were 354 mL/min and 0.61, respectively. Therefore we determine the treatment timing based on these results. Since 2012, active monitoring using US could have decreased the number of treatment patients by 100 per year. This meant that objective evaluation by US enabled treatments at a more suitable time to promote the proper use of medical expenses for EV treatment.
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Ultrasonographic comparison of two landmarks for the internal jugular vein: high versus conventional approach. Eur J Emerg Med 2015; 23:292-297. [PMID: 25734479 DOI: 10.1097/mej.0000000000000260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed and compared two landmarks (conventional vs. high approach) used in internal jugular vein (IJV) cannulation with respect to the degree of overlap with the carotid artery (CA) and the cross-sectional area (CSA) of the IJV using ultrasonography. PATIENTS AND METHODS Forty-eight adult patients were included. Using ultrasonography, the percentage overlaps with the CA and the CSA of both IJVs were measured in the supine and Trendelenburg positions using conventional and high approaches. With the conventional approach, the IJV is penetrated at the apex of Sedillot's triangle, formed by the clavicle and the sternal and clavicular heads of the sternocleidomastoid muscle. The high approach involves the midpoint between the sternal notch and the mastoid process. RESULTS The degree of overlap with the CA was 30.5 (7.5-69.4)% [median (interquartile range)] and 0.0 (0.0-25.4)% with the conventional and high approaches, respectively, for the right IJV (P<0.001) in the Trendelenburg position with 30° head rotation. The CSA of the right IJV was 1.22 (0.92-2.01) and 0.98 (0.79-1.72) cm with the conventional and high approaches, respectively (P<0.001), in the Trendelenburg position with 30° head rotation. IJV was more deeply positioned using the high approach than the conventional approach (P<0.001). CONCLUSION The high approach for IJV cannulation decreased both the degree of overlap with the CA and CSA of the IJV and increased the depth of the IJV from the skin compared with the conventional approach.
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Benassi F, Vezzani A, Vignali L, Gherli T. Ultrasound Guided Femoral Cannulation and Percutaneous Perfusion of the Distal Limb for VA ECMO. J Card Surg 2014; 29:427-9. [DOI: 10.1111/jocs.12319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Filippo Benassi
- Cardiac Surgery Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
| | - Antonella Vezzani
- Cardiac Surgery Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
| | - Luigi Vignali
- Cardiology Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
| | - Tiziano Gherli
- Cardiac Surgery Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
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